scholarly journals Outcome prediction following penetrating craniocerebral injury in a civilian population: aggressive surgical management in patients with admission Glasgow Coma Scale scores of 6 to 15

2000 ◽  
Vol 8 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Michael L. Levy
Keyword(s):  
Glasgow Coma Scale ◽  
Significant Relationship ◽  
Pupillary Response ◽  
Operative Intervention ◽  
Craniocerebral Injury ◽  
Coma Scale ◽  
Significant Relationships ◽  
Scale Scores ◽  
Gcs Score ◽  
Admission Glasgow Coma Scale

In an attempt to assess admission Glasgow Coma Scale (GCS) scores and other radiographic variables after penetrating craniocerebral injury in relationship to outcome, the author evaluated a series of 294 patients with penetrating injuries who presented with a GCS score of 6 to 15 over a 6-year period. Entrance criteria required a replicable neurological examination that was not altered by the presence of hypotension, drugs/toxins, or systemic injury. All patients underwent surgical intervention and aggressive perioperative management, including resuscitative protocols, in the neurosurgical intensive care unit. The author previously devised prospective models of outcome remained unchanged in this series. The variables most predictive of death include admission GCS score and subarachnoid hemorrhage in one model and admission GCS score and pupillary changes in a second when pupillary response was definitive at admission (p ≤ 0.00005). Other important variables related to morbidity include admission GCS, bihemispheric injury when associated with intraventricular hemorrhage, and diffuse fragmentation (p ≤ 0.001). In this study a significant relationship between operative intervention and survival (p ≤ 0.01) was found in patients with an admission GCS scores of 6 to 8. No significant relationships between operative intervention and survival were found in patients with admission GCS scores of 9 to 12 and 13 to 15. A significant relationship between operative intervention and morbidity (p ≤ 0.01) was also demonstrated in patients with an admission GCS score of 12 to 15. No significant relationships between operative intervention and morbidity were found in patients with an admission GCS score of 6 to 8 and 9 to 12.

scholarly journals Effects of Not Intubating Non-Trauma Patients With Low Glasgow Coma Scale Scores: a Retrospective Study

2022 ◽  
Vol 2 (1) ◽  
pp. 83-90
Author(s):  
Loui K Alsulimani ◽  
Ohoud Baajlan ◽  
Khalid Alghamdi ◽  
Raghad Alahmadi ◽  
Abdullah Bakhsh ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Altered Mental Status ◽  
Trauma Patients ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Coma Scale ◽  
Scale Scores ◽  
Gcs Score

Background: Endotracheal intubation (EI) is a critical life-saving procedure commonly performed on emergency department (ED) patients who present with altered mental status (AMS).  Aims: We aimed to investigate the safety of observing, without EI, patients who present to the ED with decreased levels of consciousness (LOC).  Methods: We reviewed the data of all adult ED patients with a Glasgow Coma Scale (GCS) score ≤ 8, during the period between 2012 and 2018, in an academic tertiary care centre. Trauma patients were excluded. The patients were divided into two groups for comparison: those who were intubated and those who were not. Data on mortality, morbidity, and baseline clinical characteristics were collected and analysed.  Results: After screening 6334 electronic medical records of patients presenting to the ED with decreased LOC, only 257 patients met the inclusion criteria. 173 (67.3%) patients were intubated, while 84 (32.7%) were not. Among the intubated patients, 165 (95.4%) were intubated early (within two hours of presentation). Mortality, morbidity and length of stay for the intubated group were higher, although the baseline clinical characteristics were the same.  Conclusion: It might be safe to observe non-trauma emergency patients with a GCS score ≤ 8 without intubation. However, such decision should be taken carefully, as delayed intubation can be associated with higher mortality and morbidity

Abstract 32: Optimal Threshold for Defining Early Clinical Deterioration as a Predictor of Poor Outcome in Acute Intracerebral Hemorrhage

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nerses Sanossian ◽  
May A Kim-Tenser ◽  
David S Liebeskind ◽  
Adrian M Burgos ◽  
Scott Hamilton ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Final Outcome ◽  
Clinical Deterioration ◽  
Coma Scale ◽  
Poor Outcome ◽  
Scale Scores ◽  
Acute Intracerebral Hemorrhage ◽  
Gcs Score

Background: Many patients with acute intracerebral hemorrhage (ICH) clinically deteriorate between the time of paramedic assessment in the field and Emergency Department (ED) arrival. Cohort studies have used decline in the Glasgow Coma Scale (GCS) score from prehospital assessment to ED assessment to identify patients with early clinical deterioration (ECD), but the degree of GCS decline that best correlates with poor final functional outcome has not been delineated. Methods: Consecutive cases with primary ICH on initial imaging were identified from the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 clinical trial of intravenous magnesium vs. placebo. All subjects underwent GCS evaluation in the field by paramedics within 2 hours from symptom onset, and again in the ED by study research coordinators. Poor outcome was defined as a modified Rankin Scale of 4 to 6 at 3-months. Deteriorations in GCS from one point through 10 points were evaluated in relation to poor final functional outcome through receiver operating characteristic (ROC) and area under curve (AUC). Results: Among the 369 (22%) patients with primary ICH, mean [SD] age was 65 [13] years, 34% were women, 79% White race, 34% Hispanic ethnicity, 80% had pre-existing hypertension, 20% diabetes, 18% smokers. Paramedic on scene time was a median [IQR] of 23 [15-40] minutes from last known well and time of GCS assessment in the ED was a median of 140 [119-175] minutes after last known well. Glasgow Coma Scale scores were mean 14.4 (SD 1.5) and median 15 [15-15] in the field and mean 12.1 (SD 4.5) and median 15 [10-15] in the ED, and 59% had a poor outcome at 3 months. Frequency of deteriorations on the GCS included: ≥1 point - 38%, ≥2points - 31%, ≥3 points - 27%, ≥5 points - 21%, and ≥10 points - 13%. The best performing cutpoints on the the ROC for predicting poor final outcome were ECD definitions of GCS decline of >=1: sensitivity 54% and specificity 85%; and GCS decline of >=2: sensitivity 46% and specificity 91%. The c statistic for ECD defined as a 1 point GCS decline as a predictor of poor final outcome was 0.71 (95%CI 0.66, 0.76). Conclusions: Early clinical deterioration of GCS is common and its presence may be helpful in predicting poor outcome.

scholarly journals Timing of Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction: A Single-Center Analysis

Medicina ◽  
2019 ◽  
Vol 55 (2) ◽  
pp. 31
Author(s):  
Mustafa Kilic ◽  
Devrimsel Harika Ertem ◽  
Burak Ozdemir
Keyword(s):  
Glasgow Coma Scale ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Decompressive Craniectomy ◽  
Demographic Data ◽  
High Morbidity ◽  
Middle Cerebral Artery Infarction ◽  
Coma Scale ◽  
Scale Scores ◽  
Gcs Score

Background and aim: Malignant middle cerebral artery infarction (MMCAI) usually leads to brain edema that may result in transtentorial herniation and brainstem compression. The prognosis of MMCAI is generally poor. The aim of this study was to discuss our experience with surgical decompression for MMCAI, and determine the association between timing of craniectomy and neurological outcomes. Methods: We identified consecutive patients diagnosed with MMCAI who underwent decompressive craniectomy (DC). Clinical and demographic data were obtained from electronic medical records, including: age, sex, preoperative Glasgow Coma Scale (GCS) score, surgery timing, postoperative GCS scores, and modified Rankin Scale (mRS) scores. Results: This study included 27 stroke patients (aged 38–80 years) operated within 72 h of the onset of neurological symptoms. Sixteen, five, and six patients underwent DC within 24 h, between 24 and 48 h, and after 48 h after onset of symptoms, respectively. Five patients died after the surgery. Patients who underwent DC within 24 h and 24–48 h had better mean GCS scores than those who underwent DC after 48 h (p = 0.000, p = 0.015). In addition, patients who underwent DC within 24 h had better mean postoperative mRS scores (p = 0.000) than other patients. Patients older than 60 years had significantly lower GCS scores (p = 0.027) and higher mRS scores (p = 0.033) than younger patients. Conclusion: Our findings support that DC had satisfying outcomes in patients who underwent DC within 24 h. Older age and lower Glasgow Coma Scale scores among DC patients with MMCAI are associated with high morbidity and mortality.

scholarly journals Modulated Neuroprotection in Unresponsive Wakefulness Syndrome after Severe Traumatic Brain Injury

2021 ◽  
Vol 11 (8) ◽  
pp. 1044
Author(s):  
Cristina Daia ◽  
Cristian Scheau ◽  
Aura Spinu ◽  
Ioana Andone ◽  
Cristina Popescu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Severe Traumatic Brain Injury ◽  
Functional Independence ◽  
Unresponsive Wakefulness Syndrome ◽  
Coma Scale ◽  
Severe Tbi ◽  
Neuroprotective Treatment ◽  
Gcs Score

Background: We aimed to assess the effects of modulated neuroprotection with intermittent administration in patients with unresponsive wakefulness syndrome (UWS) after severe traumatic brain injury (TBI). Methods: Retrospective analysis of 60 patients divided into two groups, with and without neuroprotective treatment with Actovegin, Cerebrolysin, pyritinol, L-phosphothreonine, L-glutamine, hydroxocobalamin, alpha-lipoic acid, carotene, DL-α-tocopherol, ascorbic acid, thiamine, pyridoxine, cyanocobalamin, Q 10 coenzyme, and L-carnitine alongside standard treatment. Main outcome measures: Glasgow Coma Scale (GCS) after TBI, Extended Glasgow Coma Scale (GOS E), Disability Rankin Scale (DRS), Functional Independence Measurement (FIM), and Montreal Cognitive Assessment (MOCA), all assessed at 1, 3, 6, 12, and 24 months after TBI. Results: Patients receiving neuroprotective treatment recovered more rapidly from UWS than controls (p = 0.007) passing through a state of minimal consciousness and gradually progressing until the final evaluation (p = 0.000), towards a high cognitive level MOCA = 22 ± 6 points, upper moderate disability GOS-E = 6 ± 1, DRS = 6 ± 4, and an assisted gait, FIM =101 ± 25. The improvement in cognitive and physical functioning was strongly correlated with lower UWS duration (−0.8532) and higher GCS score (0.9803). Conclusion: Modulated long-term neuroprotection may be the therapeutic key for patients to overcome UWS after severe TBI.

408: Scene Glasgow Coma Scale Scores Can Help Predict Mortality in Pediatric Blunt Trauma

2008 ◽  
Vol 52 (4) ◽  
pp. S166
Author(s):  
C.B. Irvin ◽  
K.E. Duemling ◽  
T. Oberg ◽  
A.M. Ads
Keyword(s):  
Glasgow Coma Scale ◽  
Blunt Trauma ◽  
Coma Scale ◽  
Scale Scores

Missile injury to the pediatric brain in conflict zones

2011 ◽  
Vol 7 (3) ◽  
pp. 276-281 ◽  
Author(s):  
Abrar A. Wani ◽  
Altaf U. Ramzan ◽  
Nayil K. Malik ◽  
Abdul Qayoom ◽  
Furqan A. Nizami ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Pediatric Population ◽  
Developed Countries ◽  
Multinomial Regression ◽  
Chi Square ◽  
Conflict Zones ◽  
Coma Scale ◽  
Hemodynamic Status ◽  
Missile Injury ◽  
Gcs Score

Object This study was conducted both prospectively and retrospectively at one center over a period of 8 years. The population consisted of all patients with both an age 18 years or younger and a diagnosed penetrating missile injury (PMI) during the study interval. The authors analyzed factors determining outcome and demographic trends in this population, and they compared them with those in the more developed world Methods Fifty-one patients were the victims of armed conflict, although no one was directly a party to any battle. This mechanism of injury is in strong opposition to data in the literature from developed countries, in which most missile injuries are the result of suicide or homicide or are even sports related. Moreover, all previous studies on the pediatric population have considered only injuries from gunshots, but authors of the current study have included injuries from other penetrating missiles as well. Results On cross tabulation analysis using the chi-square test, the factors shown to correlate with outcome included the Glasgow Coma Scale (GCS) score, pupillary abnormalities, patient age, hemodynamic status, and bihemispheric damage. On multinomial regression analysis, the two strongest predictors of death were GCS score and pupillary abnormalities. The GCS score and hemodynamic status were the strongest predictors of disability. Conclusions There was no difference in the prognostic factors for PMI between developing or more developed countries. Glasgow Coma Scale score, pupillary abnormalities, and hemodynamic status were the strongest predictors of outcome. In conflict zones in developing countries the victims were mostly innocent bystanders, whereas in the more developed countries homicides and suicides were the leading etiological factors.

scholarly journals Factors influencing the outcome of patients with acute extradural haematomas undergoing surgery

1970 ◽  
Vol 10 (2) ◽  
pp. 112-120 ◽  
Author(s):  
MJ Islam ◽  
SK Saha ◽  
MF Elahy ◽  
KMT Islam ◽  
SU Ahamed
Keyword(s):  
Glasgow Coma Scale ◽  
Glasgow Outcome Scale ◽  
Road Traffic ◽  
Medical Science ◽  
Extradural Haematoma ◽  
Common Cause ◽  
Coma Scale ◽  
Male Predominance ◽  
Factors Influencing ◽  
Gcs Score

Background: Acute extradural haematoma (EDH) remains most common cause of mortality and disability resulting from traumatic brain injury. In the last three decades, improvements in rescue, neuromonitoring, diagnostic procedure and intensive care have led to better outcomes. The purpose of this study was to evaluate the factors influencing the outcome in patients with EDH undergoing surgery treated in a tertiary hospital in Bangladesh. Methods: In this retrospective study, 102 consecutive patients with acute EDH who underwent craniotomy were included. The study was carried out from July 2003 to December 2005. The diagnosis was made clinically and radiologically by CT scan. Patients were grouped on the basis of Glasgow Coma Scale (GCS) and operative outcomes were evaluated by Glasgow Outcome Scale (GOS) Results: More than half sampled respondents’ (57%) age were more than 20 years while rests of the patients below 20 years with male predominance (Male: Female -12:1). About 7 in 10 respondents (70.6%) were working. Similarly, majority of the respondents (79.4%) had lost more than 30 ml blood. A notable proportion of the respondents (73.5%) had good GCS score (9-15 score) during admission. Similarly majority of the respondents (70.6%) had GCS score 9-15 and 29.4% had GCS score 3-8 before surgery. Road Traffic Accident (RTA) (65%) is the most common cause of EDH followed by assault (20%) and fall from height (12%). Temporal and temporo-parietal locations were the most common site of EDH (56%). Patients with good GCS before surgery had significantly better outcome (89%) compare to those who had bad GCS (10%). Conclusion: Level of consciousness before surgery is the most important factor affecting the outcome. Hence, early diagnosis and surgical intervention is very essential. Key words: Acute Extradural Haematoma (EDH); Glasgow Coma Scale (GCS); Glasgow Outcome Scale (GOS). DOI: http://dx.doi.org/10.3329/bjms.v10i2.7806 Bangladesh Journal of Medical Science Vol.10 No.2 Apr’11 pp.112-120

scholarly journals Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severity

2018 ◽  
Vol 128 (6) ◽  
pp. 1612-1620 ◽  
Author(s):  
Paul M. Brennan ◽  
Gordon D. Murray ◽  
Graham M. Teasdale
Keyword(s):  
Patient Outcome ◽  
Mortality Rate ◽  
Glasgow Coma Scale ◽  
Brain Damage ◽  
Unfavorable Outcome ◽  
Simple Arithmetic ◽  
Coma Scale ◽  
Pupil Response ◽  
Gcs Score ◽  
Complex Methods

OBJECTIVEGlasgow Coma Scale (GCS) scores and pupil responses are key indicators of the severity of traumatic brain damage. The aim of this study was to determine what information would be gained by combining these indicators into a single index and to explore the merits of different ways of achieving this.METHODSInformation about early GCS scores, pupil responses, late outcomes on the Glasgow Outcome Scale, and mortality were obtained at the individual patient level by reviewing data from the CRASH (Corticosteroid Randomisation After Significant Head Injury; n = 9,045) study and the IMPACT (International Mission for Prognosis and Clinical Trials in TBI; n = 6855) database. These data were combined into a pooled data set for the main analysis.Methods of combining the Glasgow Coma Scale and pupil response data varied in complexity from using a simple arithmetic score (GCS score [range 3–15] minus the number of nonreacting pupils [0, 1, or 2]), which we call the GCS-Pupils score (GCS-P; range 1–15), to treating each factor as a separate categorical variable. The content of information about patient outcome in each of these models was evaluated using Nagelkerke’s R2.RESULTSSeparately, the GCS score and pupil response were each related to outcome. Adding information about the pupil response to the GCS score increased the information yield. The performance of the simple GCS-P was similar to the performance of more complex methods of evaluating traumatic brain damage. The relationship between decreases in the GCS-P and deteriorating outcome was seen across the complete range of possible scores. The additional 2 lowest points offered by the GCS-Pupils scale (GCS-P 1 and 2) extended the information about injury severity from a mortality rate of 51% and an unfavorable outcome rate of 70% at GCS score 3 to a mortality rate of 74% and an unfavorable outcome rate of 90% at GCS-P 1. The paradoxical finding that GCS score 4 was associated with a worse outcome than GCS score 3 was not seen when using the GCS-P.CONCLUSIONSA simple arithmetic combination of the GCS score and pupillary response, the GCS-P, extends the information provided about patient outcome to an extent comparable to that obtained using more complex methods. The greater range of injury severities that are identified and the smoothness of the stepwise pattern of outcomes across the range of scores may be useful in evaluating individual patients and identifying patient subgroups. The GCS-P may be a useful platform onto which information about other key prognostic features can be added in a simple format likely to be useful in clinical practice.

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